In struggling NHS A&E departments, locum doctors are being paid in excess of
£1,000 per shift while consultants received more than £3,000 and nurses up
to £1,600

Doctors are being paid as much as £3,000 per shift by NHS hospitals to fill “endemic” staff shortages in Accident & Emergency units, an investigation by The Telegraph has found.

On at least 2,300 occasions last year, locum doctors were paid in excess of £1,000 to plug the gaps in rotas at crisis-hit A&E departments, according to official figures.

This included consultants being paid rates of more than £3,000 per shift, with nurses paid up to £1,600.

According to the figures, the highest single amount spent was by Wye Valley NHS Trust, in Herefordshire, which paid £3,717 for one doctor to work a 30-hour shift last September.

The trust did not specify how much of this 30-hour period the doctor spent working at the hospital, and how much of it they spent on call. Heatherwood and Wexham Park Hospitals Foundation Trust paid out £3,027 for a locum doctor to work one 24-hour shift.

All the sums included fees paid to agencies, which usually take around 15 per cent of the bill. Some doctors were rewarded not just for the hours they worked, but for all the time they were on call, including when they were sleeping.

The figures suggest that the total bill for these agency workers in 2013 was almost £250 million, a rise of one third in two years. This would have been enough to pay the annual wages of 3,000 consultants or more than 7,000 junior doctors.

Experts said the figures disclosed the full extent of a crisis in which casualty departments have become “entirely dependent” on temporary workers, amid desperate shortages of senior doctors and consultants.

Senior managers have previously insisted that rates of £1,000 per shift or more are paid only in crisis situations where there is no alternative.

The investigation by The Telegraph shows that NHS trusts are routinely paying out such sums to meet staff shortages.

The analysis found:

Heart of England NHS Foundation Trust in Birmingham paid at least £1,000 per shift on 719 occasions last year;

Kettering General Hospital Foundation Trust paid such rates 595 times in 2013, while Northern Devon Healthcare Trust did so for 255 shifts;

Barking, Redbridge and Havering University Hospitals Trust in Essex had the highest bill for A&E agency staff, spending £7.1 million last year, including 217 shifts paid at rates of at least £1,000 each.

The hospital was recently put on special measures after its casualty unit was found to have the worst shortages of senior doctors in the country, with 13 out of 21 posts vacant.

The College of Emergency Medicine, which represents A&E doctors, says there is a shortage of almost 400 consultants in Britain.

They say shortages have occurred because not enough doctors were trained, while hundreds more have emigrated to countries where the workload is less onerous.

Experts say the crisis is prompting consultants to take on extra work at highly lucrative rates, while others come here from abroad.

Dr Cliff Mann, president of the College of Emergency Medicine, said: “The use of agency doctors has become endemic in the NHS. There are units which would implode if they weren’t relying on them, day in, day out.”

Dr Mann, the most senior A&E doctor in the UK, added: “The figures are shocking and ludicrous. The worst of it is that with the money we are wasting on temporary staff we could double the number of A&E consultants, if only a more long-term approach was taken. It doesn’t make economic sense, nor does it make clinical sense — because this is not good for patients.”

In total, 64 hospital trusts, out of 144 with A&E departments, responded in some form to freedom of information requests.

Of those, 36 trusts provided details on how many times they had paid more than £1,000 to cover a shift in A&E in 2013. Between them, they spent such sums on 2,317 occasions last year — the equivalent of 9,268 shifts, when extrapolated to cover all 144 hospital trusts in England with a casualty unit.

The trusts provided details of the highest amounts paid to a single doctor or nurse at any time since 2011. At Lancashire Teaching Hospitals Foundation Trust, a consultant was paid £2,400 in May 2012 to work nine hours in the hospital, plus 15 hours on call.

Hospitals also spent heavily plugging gaps for nurses. Royal Devon and Exeter Foundation Trust paid £1,620 for a 12-hour nursing shift in January 2012, while University Hospitals Bristol Foundation Trust spent £1,235 on an 11.5-hour shift last April. Nearby North Bristol Trust spent £1,150 on a 12-hour shift in May last year.

Amid desperate shortages, even the most junior staff were paid at inflated rates. Walsall Healthcare Trust paid £968 for a clinical support worker to work an 11.5-hour shift last Christmas. Such staff, who assist in clinics and laboratories, are normally paid between £14,000 and £17,000 per year.

The trusts also provided figures for the overall total spend on temporary medics for each of the last three years. These were used to calculate an NHS-wide figure, which shows £242 million spent last year, compared with £181 million in 2011 — a rise of 33 per cent.

Many of the trusts said they struggled to find staff because of the national shortage of consultants and that safety of patients came first. Several said they were working to reduce their spending on agency staff, but that payments were in line with standard fees paid for locum staff.

Heart of England NHS Foundation Trust said it was one of the largest trusts in the UK, and that its priority was providing safe care, which sometimes meant exceeding standard costs. It said it had just recruited 10 more A&E doctors.

Kettering General Hospital Foundation Trust said reducing spending on agency staff was a priority, while Northern Devon Healthcare Trust said it suffered “abnormally high” staff sickness among A&E consultants last year.

Wye Valley Trust said its difficulties were compounded by its rural location in Herefordshire.

Barking, Redbridge and Havering University Hospitals Trust said it was working “tirelessly” to recruit staff despite the national shortage. Last winter, senior medics warned that A&E units were like “war zones” as they struggled to cope with rising numbers of patients, many of whom had failed to secure help from out-of-hours GPs.

On Friday, figures disclosed that casualty departments have had their worst week yet, with 100 of England’s 144 NHS trusts with A&E units missing targets to treat patients within four hours.

A Department of Health spokesman said: “Holding on to doctors in A&E has been a problem for over a decade. There are more than 20 per cent more A&E consultants than there were in 2010, but we know we need even more and we have a plan to make that happen.”

A spokesman for NHS England said: “We recognise there are difficult issues around senior medical staffing in the emergency medicine specialty, and this is compounding pressure on hospitals as A&E attendances increase year-on-year.”